Exam 3 CNS Flashcards

1
Q

What is GFAP?

A

Glial fibrillary acidic protein. it is a protein that astrocytes make when injury detected in the brain

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2
Q

T/F GFAP is collagen

A

False

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3
Q

What is the function of oligodendrocytes?

A

to myelinate axons and provide insulation to propogate action potential going down the axon

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4
Q

These cells are resident macrophages of the brain

a. oligodendrocytes
b. astrocytes
c. neurons
d. microglial cells

A

D. microglial cells

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5
Q

What is the function of microglial cells:

A

To clear damage - phagocytic and they migrate to areas of damage

when there is damage, they proliferate

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6
Q

What does a stroke look like on stain?

A

very large amount of cytoplasm and bulbbly because full of lipid material = full of myelin

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7
Q

If the BBB is damaged, what happens to the brain

A

it swells

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8
Q

What are the two types of brain swelling?

A

Vasogenic Cerebral Edema

Cellular/ Cytotoxic Cerebral Edema

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9
Q

Tx of vasogenic cerebral edema?

A

Mannitol or Decardon

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10
Q

This type of edema is caused by fluid entering the extracellular space

a. vasogenic cerebral edema
b. cellular cerebral edema

A

a

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11
Q

What is vasogenic cerebral edema associated with?

a. brain tumor
b. stroke
c. hypertension
d. brain abscess
e. A and D

A

E

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12
Q

This is an untreatable form of cerebral edema
becasue it occurs intracellularly:
a. vasogenic cerebral edema
b. cellular cerebral edema

A

B.

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13
Q

What is cellular cerebral edema associated with?

a. brain tumor
b. stroke
c. hypertension
d. brain abscess
e. A and D

A

B. stroke

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14
Q

If a person has a mixture of both vasogenic and cellular cerebral edema, will mannitol treat their condition?

a. No
b. yes no matter when they are treated
c. yes, only in the early stages

A

C. early stages

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15
Q

What is a possible complication of when the brain over-swells?

A

transtentorial herniation

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16
Q

T/F The brain, like most other organs, has a lymphoid drainage system

A

False, no draining of lymph

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17
Q

What is hydrocephalus?

A

build up of CSF in the lateral and 3rd ventricles

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18
Q

T/F the brain has no glycogen stores

A

TRUE

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19
Q

How long does it take you to lose consciousness if you are deprived of oxygen?

a. 15-20 seconds
b. 1-2 minutes
c. 3-4 minutes
d. 5-6 minutes
e. 10 minutes

A

A. 15- 20 seconds

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20
Q

At what point do you start losing neurons?

a. 15-20 seconds
b. 1-2 minutes
c. 3-4 minutes
d. 5-6 minutes
e. 10 minutes

A

B

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21
Q

How many ml of O2 per minute do nuerons require?

a. 500-600
b. 75-100
c. 300-400
d. 1000-2000

A

A

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22
Q

This is defined as arrest of or inadequate blood flow

a. anoxia
b. hypoxia
c. ischemia
d. eosinophilic degranulation

A

C. ischemia

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23
Q

This is defined as the absence of oxygen:

a. anoxia
b. hypoxa
c. ischemia
d. eosinophilic degranulation

A

A.

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24
Q

This is defines as reduced oxygen supply:

a. anoxia
b. hypoxa
c. ischemia
d. eosinophilic degranulation

A

B

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25
Q

How many neurons does the brain have?

A

100 billion

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26
Q

How much does the brain weigh?

A

2.5 pounds

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27
Q

This is defined as a sudden loss of neurologic function related to a problem with the cerebral vascular supply

A

Stroke

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28
Q

What are the two types of stroke

A

ischemic + hemorrhage

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29
Q

T/F Each 100 g of brain tissue must receive 50 ml of blood per minute

A

True

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30
Q

What is the difference between an ischemic and a hemorrhagic stroke?

a. A hemorrhagic stroke is when there is too little blood and an ischemic stroke is when blood is leaving the vascular spaces
b. A hemorrhagic stroke is when blood is leaving the vascular spaces and an ischemic stroke is when there is too little blood
c. there is no difference between the two

A

B

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31
Q

T/F Stroke is the leading cause of long term disability

A

True

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32
Q

When the brain is only getting 20 ml/100g, what does the EEG look like?

a. normal
b. amplitude increased
c. amplitude decreased
d. isoelectric
e. absent

A

C

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33
Q

When the brain is getting 15ml/100g, what does the EEG look like?

a. normal
b. amplitude increased
c. amplitude decreased
d. isoelectric
e. absent

A

D. isolectric aka no waves, no evoked cortical response & absent electrical activity

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34
Q

In terms of large hemispheric strokes, what is the most common artery that is affected?

a. anterior cerebral
b. middle cerebral
c. posterior cerebral
d. all the same

A

B middle

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35
Q

These are slit like infarcts that are small and typically arise in the basal ganglia (caudate + putamen) that may ALSO occur in the pons in pts with diabetes or hypertension.

a. embolic infarcts
b. lacunar infarcts
c. thrombus in left auricle
d. none of the above

A

B. lacunar

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36
Q

Which of the following are common sources of cerebral embolism?

a. ulcerative atherosclerosis of the common + internal carotid arteries
b. thrombus in the left auricle in pts w a fib
c. acute bacterial endocarditis
d. all of the above
e. none of the above

A

D.

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37
Q

These infarcts are peripheral in nature, tend to be multiple + hemorrhagic and can arise from many different sources

a. embolic infarcts
b. lacunar infarcts

A

A. embolic

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38
Q

Subarachnoid hemorrhages occur :

a. between dura mater + skull
b. between dura + epicure
c. between dura + pia mater
d. between pia mater + arachnoid mater

A

D

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39
Q

most common cause of subarachnoid hemorrhages?

A

berry aneurysms in the circle of willis

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40
Q

Berry aneurysms are related to a defect where?

A

in the INTERNAL elastic lamina

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41
Q

T/F Berry aneurysms usually appear as one lesion

A

False, frequently multiple

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42
Q

This type of aneurysm is due to the rupture of blood vessels in the parenchyma of hte brain that quikcly ruptures into the ventricular system and kills the patient

a. subarachnoid hemorrhage
b. Primary Intracerebral Hemorrhage

A

b. Primary Intracerebral Hemorrhage

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43
Q

What is the true prevention of Primary Intracerebral Hemorrhages?

A

Decreased BP!!!

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44
Q

What is the 3rd most common cause of death and leading cause of long term neurologic disability?

A

Stroke

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45
Q

T/F Berry aneurysms are related to defects in the vessel wall that are probably developmental in nature

A

TRUE! probably born with it and then it develops in hte mid 20s

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46
Q

What is the primary tumor of the brain?

A

Astrocytoma (which is a glioma (tumor of glial cells))

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47
Q

A glioblastoma is:

a. low grade
b. medium grade
c. high grade

A

C high grade

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48
Q

This ring contrast enhacement is seen on a CT or MRI scan and is evident of what?

a. glioblastoma
b. medulloblastoma
c. meningioma
d. none of hte above

A

Glioblastoma! used to diagnose!

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49
Q

What is the tx of glioblastomas?

A

surgery, chemo or radiation but these are last months, not years

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50
Q

This is a rapidly growing tumor that commonly occurs around the 4th ventricle, causing hydrocephalus

a. glioblastoma
b. medulloblastoma
c. meningioma
d. primary cerebral lymphoma
e. acoustic neuroma/schwannoma

A

b. medulloblastoma

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51
Q

This type of tumor may arise anywhere in the cerebrum, cerebellum or brainstem + is composed primarily of B cells. A HIGH percentage is caused by EBV, survival rate is 3-4 years

a. glioblastoma
b. medulloblastoma
c. meningioma
d. primary cerebral lymphoma
e. acoustic neuroma/schwannoma

A

D

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52
Q

This is a common, slow growing , non invasive type of tumor that typically presents with seizures. On MRI psammoma bodies are seen

a. glioblastoma
b. medulloblastoma
c. meningioma
d. primary cerebral lymphoma
e. acoustic neuroma/schwannoma

A

C. meningioma

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53
Q

Since these type of tumors dont invade, surgery is the mainstay of treatment for them

a. glioblastoma
b. medulloblastoma
c. meningioma
d. primary cerebral lymphoma
e. acoustic neuroma/schwannoma

A

C

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54
Q

This tumor can give rise to hyperostosis of overlying skull and is more common in females in the 7th decade

a. glioblastoma
b. medulloblastoma
c. meningioma
d. primary cerebral lymphoma
e. acoustic neuroma/schwannoma

A

C. meningioma

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55
Q

This tumor arises in the vestibular division of hte 8th nerve that causes unilateral deafness

a. glioblastoma
b. medulloblastoma
c. meningioma
d. primary cerebral lymphoma
e. acoustic neuroma/schwannoma

A

E

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56
Q

How do you diagnose schwannomas?

a. CT
b. XRAY
c. MRI
d. H&P

A

c. MRI

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57
Q
What is the MOST common site of metastasis to the brain?
A. Lung
b. breast
c. melanoma
d. thyroid
e. kidney
A

LUNG!!!!!!!!!!!!

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58
Q

Which of the following typically metastasizes to the brain?

a. Abdominal carcinoma
b. Gynecological cancers
c. Prostate cancers
d. Pulmonary cacner

A

D. pulmonary

59
Q

Pt presents with prostate cancer. After MRI, you find multiple metastases in the brain. Where did he most likely obtain these metastases from?

a. His prostate gland
b. His GI tract
c. His lungs
d. The primary tumor was in the brain and spread to the prostate

A

C. Lungs

60
Q

What is the MOST common presenting symptom of a metastasis to the brain causing initital symtpoms?

A

GRAND MAL SEIZURE

61
Q

T/F ALS is a disease of both upper + motor neurons

A

TRUE

62
Q

T/F In ALS the LATERAL CORTICOSPINAL TRACTS (and sometimes the anterior corticospinal tracts) selectively degenerate.

A

True

63
Q

What is amyotrophy?

A

The atrophy of muscles related to LOSS of innervation - need to have neuronal innervation loss for it to be considered amyotrophy

64
Q

T/F The intellect, sphincter control and sensation of an ALS patient remains intact throughout the course of the disease

A

True

65
Q

What is the protein inside the Lewy bodies called?

A

alpha synuclein

66
Q

What are the three types of genetic testing for HD?

A

diagnostic
presymptomatic
prenatal

67
Q

T/F The degree of atrophy of an elderly persons brain makes the diagnosis of alzheimers disease

A

FALSE. there is not enough of a difference from the normal elderly brain to make the diagnosis

68
Q

What are the two proteins that accumulate in the brain of an alzheimers patient?

A

Tau = neurofibrillary tangles

beta amyloid plaques

69
Q

What is the major area where neurons in alzheimers disease degenerate?

A

Nucleus Basalis meynert aka the basal forebrain

70
Q

What type of drug is aracept?

A

Cholinergic drug

71
Q

What is an uncommon cause of dementia that is categorized by abrupt onset, history of stroke, fluctuating course, focal neurolgic signs an symptoms?

A

Multi- infarct dementia

72
Q

Neurofilament?

a. alzheimer’s
b. parkinson’s
c. ALS
d. Huntington’s

A

c ALS

73
Q

Intranuclear + cytoplasmic inclusions (huntington)

a. alzheimer’s
b. parkinson’s
c. ALS
d. Huntington’s

A

D

74
Q

alpha synuclein?

a. alzheimer’s
b. parkinson’s
c. ALS
d. Huntington’s

A

A

75
Q

where is the inflammatory response in a person with acute bacterial meningitis?

A

in the subarachnoid space

76
Q

With what age group do you see H flu causing meningitis?

a. neonates
b. children
c. epidemics
d. elderly

A

b children - not commonly seen know because of vaccines

77
Q

With what age group do you see meningococcal meningitis?

a. neonates
b. children
c. epidemics
d. elderly

A

C epidemics

78
Q

With what age group do you see pneumoccocal meningitis?

a. neonates
b. children
c. epidemics
d. elderly

A

D. elderly

79
Q

Brain abscesses are commonly seen with?

A

vasogenic edema

80
Q

What are the two causes of brain abscesses

A

Local or hematogenous

81
Q

Difference btween pathogenic and opportunistic organisms?

A
Pathogenic = every individual
Opportunistic = only in pts w decreased resistnace to organisms + pts w pre-existing conditions
82
Q

This is an opportunistic infection that occurs more commonly int he base of the brain (chronic basilar meningitis)

a. Mucomycosis
b. PMLE
c. Cryptococcal meningitis
d. Toxoplasmosis
e. other fungi

A

C

83
Q

T/F Cryptococcal meningitis ALWAYS spreads from the lungs

A

TRUE

84
Q

What does the histology of virtually all forms of viral encephalitis look like?

A

perivascular chronic inflammatory cell infiltrates

85
Q

Poliomyelitis is the acute viral attack of what?

a. sensory neurons
b. muscle
c. bone
d. motor neurons
e. skin

A

D motor neurons

86
Q

This is an acute, necrotizing, hemorrhagic infection of the frontal + temporal lobes

a. Poliomyelitis
b. Herpes Encephalitis
c. Rabies
d. Arboviral Encephalitis
e. HIV
f. Progressive multifocal leukoencephalopathy PMLE

A

B

87
Q

This is the MOST common form of acute viral encephalitis in the US

a. Poliomyelitis
b. Herpes Encephalitis
c. Rabies
d. Arboviral Encephalitis
e. HIV
f. Progressive multifocal leukoencephalopathy PMLE

A

B

88
Q

This virus has cowdry A inclusion bodies

a. Poliomyelitis
b. Herpes Encephalitis
c. Rabies
d. Arboviral Encephalitis
e. HIV
f. Progressive multifocal leukoencephalopathy PMLE

A

B

89
Q

This is an opportunistic viral infection that affects oligodendroglia cells and produces multiple foci of myelin damage

a. Poliomyelitis
b. Herpes Encephalitis
c. Rabies
d. Arboviral Encephalitis
e. HIV
f. Progressive multifocal leukoencephalopathy PMLE

A

F

90
Q

These cells are infected by hte JC virus (an SV 40like virus)

a. Poliomyelitis
b. Herpes Encephalitis
c. Rabies
d. Arboviral Encephalitis
e. HIV
f. Progressive multifocal leukoencephalopathy PMLE

A

F

91
Q

This is a disturbance of neurological function caused by trauma

a. Concussion
b. Contusion
c. Laceration
d. Diffuse axonal injury
e. None of the above

A

A. concussion

92
Q

T/F you need to lose consciousness to have a concussion

A

FALSE

93
Q

This is a superficial bruise that is confined to the GREY matter of the brain

a. Concussion
b. Contusion
c. Laceration
d. Diffuse axonal injury
e. None of the above

A

B contusion

94
Q

What is the difference between coup and countercoup lesions?

A

Coup: the superficial bruise at the point of impact
Countercoup: the more extensive lesion on the contralteral aspect of the brain

95
Q

This is an injury that extends through the gray matter into the white matter

a. Concussion
b. Contusion
c. Laceration
d. Diffuse axonal injury
e. None of the above

A

C. laceration

96
Q

This is related to the rotational forces in the brain, resulting in shearing axons

a. Concussion
b. Contusion
c. Laceration
d. Diffuse axonal injury
e. None of the above

A

D

97
Q

Coup + contra-coup are related to which of the following?

a. Concussion
b. Contusion
c. Laceration
d. Diffuse axonal injury
e. None of the above

A

B. contusion

98
Q

T/F Chronic Traumaitc Encephalopathy is seen in boxers and is histoloigically distinguised from alzheimers disease becuase it only has beta amyloid protein, not tau proteins

A

FALSE
CTE has zillions of TAU (neurofibrillary tangles)
NOT beta amyloid!

99
Q

This part of the brain is associated with memory problems

a. frontal lobes
b. hippocampus
c. hypothalamus
d. anterior insular cortex

A

B hippocampus

100
Q

This part of the brain is associated with emotional responses, impulsitivity and addictive behavior

a. frontal lobes
b. hippocampus
c. hypothalamus
d. anterior insular cortex
e. temporal lobes

A

D

101
Q

This location of the brain is associated with decision making, judgement, affect, planning, impulsivitiy

a. frontal lobes
b. hippocampus
c. hypothalamus
d. anterior insular cortex
e. temporal lobes

A

A

102
Q

This part of hte brain is associated with sleep disorders + stress reactions

a. frontal lobes
b. hippocampus
c. hypothalamus
d. anterior insular cortex

A

C

103
Q

T/F You start to see an increase in tau proteins immediately after a TBI

A

False, there is a latency period

104
Q

What are the myelin cells of the PNS called?

A

Schwann cells

105
Q

How are schwann cells and oligodendrocytes different?

A

Schwann cells only provide myelination for ONE axon, not for adjacent axons like oligodendrocytes do

106
Q

Which nerve is most commonly biopsied in order to diagnose peripheral nerve problems?

a. tibial
b. median
c. sural
d. fibular
e. radial

A

C. sural

107
Q

This is the generalized relatively homogenous process affecting many peripheral nerves. Distal portions are more typically affected most prominently

a. mononeuropathy
b. polyneuropathy
c. mononeuropathy multiplex

A

B

108
Q

This is the simultaneous or sequential involvement of non-contiguous nerve trunks

a. mononeuropathy
b. polyneuropathy
c. mononeuropathy multiplex

A

C

109
Q

Multiple nerve infarcts related to a systemic vasculitis involving the vasa nervorum is an example of what:

a. mononeuropathy
b. polyneuropathy
c. mononeuropathy multiplex

A

C

110
Q

Neuropathy or myopathy?

Distal weakness

A

neuropathy

111
Q

Neuropathy or myopathy?

preserved reflexes

A

myopathy

112
Q

Neuropathy or myopathy?

muscle pain is a common complaint

A

myopathy

113
Q

Neuropathy or myopathy?

fasciculations commonly seen

A

neuropathy

114
Q

Neuropathy or myopathy?

sensory loss

A

neuropathy

115
Q

Neuropathy or myopathy?

dysesthesia

A

neuropathy

116
Q

guillan barre syndrome is treated how?

a. surgery
b. chemotherapy
c. radiation
d. steroids
e. good nursing care

A

E

117
Q

What is the most common form of diabetic neuropathy?

a. distal diabetic polyneuropathy
b. diabetic multiple mononeuropathy + radiculopathy
c. alcoholic polyneuropathy

A

A

118
Q

This is thought to arise from the vasa nervorum - narrowing of the lumen

a. distal diabetic polyneuropathy
b. diabetic multiple mononeuropathy + radiculopathy
c. alcoholic polyneuropathy

A

A.

119
Q

This is a painful asymmetric multiple neuropathy that begins as pain in the back and spreads to the thigh and knee

a. distal diabetic polyneuropathy
b. diabetic multiple mononeuropathy + radiculopathy
c. alcoholic polyneuropathy

A

B

120
Q

This type of neuropathy is mostly motor impairment

a. distal diabetic polyneuropathy
b. diabetic multiple mononeuropathy + radiculopathy
c. alcoholic polyneuropathy

A

B

121
Q

This type of neuropathy is both sensory + motor impairment

a. distal diabetic polyneuropathy
b. diabetic multiple mononeuropathy + radiculopathy
c. alcoholic polyneuropathy

A

C

122
Q

What is it called when the tumor is growing within the nerve?

A

a plexiform neurofibroma

123
Q

What segment does wallerian degeneration occur?

a. proximal
b. distal
c. both proximal and distal

A

B distal

124
Q

T/F Peripheral nerves are different from central nerves in that they have the ability to reconstitute themselves

A

True

125
Q

What is it called when a peripheral nerve is lacerated and in its attempts to regenerate, cannot meet its other half?

A

traumatic neuroma

126
Q

What is the most common form of entrapment neuropathy?

a. median nerve compression
b. radial nerve compression
c. ulnar nerve compression
d. saturday night palsy

A

a- CPT

127
Q

T/F Men commonly present more frequently with carpal tunnel syndrome, compared to women

A

False women more than men

128
Q

Saturday night palsy is compression of which of the following nerves?

a. median
b. ulnar
c. radial
d. tibial
e. sural

A

radial

129
Q

What is morton’s neuroma?

a. a true neuroma
b. a neoplastic lesion
c. a traumatic nueroma
d. a intermetatarsal entrapment neuropathy

A

D

130
Q

This type of synapse is modulatory

a. axodendritic
b. axoaxonal
c. axosomatic
d. A and B
e. B and C

A

B

131
Q

This type of synapse is excitatory

a. axodendritic
b. axoaxonal
c. axosomatic
d. A and B
e. B and C

A

A

132
Q

This type of synapse is inhibitory

a. axodendritic
b. axoaxonal
c. axosomatic
d. A and B
e. B and C

A

C

133
Q

How many neurons are in the brain?

a. 100 million
b. 500 million
c. 100 billion
d. 500 billion
e. 1 trillion

A

C

134
Q

How much does the brain weight?

a. 1.5 lbs
b. 2.5 lbs
c. 3.5 lbs
d. 4.5 lbs
e. 5.5 lbs

A

B

135
Q

What is gliosis?

A

the deposition of glial fibers by astrocytes

136
Q

What type of healing occurs with ischemic strokes?

A

glial scar formation + cavitation

137
Q

How much CO does the brain receive from the heart?

a. 10%
b. 15%
c. 20%
d. 25%
e. 30%

A

C. 20%

138
Q

What is the true prevention of hemorrhagic stroke (intracerebral hemorrhages)?

a. weight loss
b. surgery
c. controlling BP
d. none of the above

A

C

139
Q

Uncal herniation is a complication of?

A

intracerebral hemorrhaging

140
Q

T/F Medulloblastomas fill the 4th ventricle but first fills the cerebellum

A

TRUE

141
Q

T/F Metastatic cancer to the brain is almost invariably derived from SARCOMAS

A

FALSE, CARCINOMAS!!!

142
Q

Where is the selective degneration in Alzheimer’s?

a. cerebellum
b. hippocampus + nucleus basalis of meynert
c. caudate + putamen
d. pons
e. frontal lobe of cerebrum

A

B

143
Q

How many nephrons are there per kidney?

a. 1 million
b. 10 million
c. 100 million
d. 1 billion
e. 100 billion

A

A